For muscle cramps, there’s no good cure


— Cramps, those annoying contractions of muscles, particularly in the
legs, may not be lethal, but they can be extremely painful.
Surprisingly, there are no really good treatments for them, according
to new guidelines issued Tuesday by the American Academy of Neurology
in the journal Neurology. But one treatment that should be avoided,
except as a last resort when nothing else works, is quinine, according
to the guidelines developed by Dr. Hans D. Katzberg of the Stanford University School of Medicine and his colleagues.

Quinine, the essential ingredient in tonic water,
has long been the preferred treatment for cramps. Studies have shown
that it can reduce the incidence and severity of cramps by one-third to
one-half. The problem is that, in as many as one in 25 cases, quinine
can produce serious adverse effects, including blood irregularities. In
2006, the Food and Drug Administration warned against the use of
quinine for treating cramps because of the large number of adverse
event reports it had received, and the drug is not readily available in
this country — although it is still sold over the counter in many
foreign countries.

And no, you can’t get useful amounts of the drug by drinking tonic: It would require at least a few liters.

“Quinine should be considered only when cramps are
very disabling, when no other drugs relieve the symptoms and when side
effects are carefully monitored” by a physician, Katzberg said in a
statement. “It should also be used only after the affected person is
informed about the potentially serious side effects.”

Other agents that are sometimes used to treat cramps
include the anti-spasmodic drug naftidrofuryl, the anti-hypertension
drug Diltiazem and vitamin B complex. These drugs may be safely used,
the guidelines say, but there is surprisingly little data about whether
or not they work. There is also almost no data about the value of
stretching calves to reduce cramps or drinking large quantities of
water, both frequently offered as remedies. But both are considered
safe if done in moderation.

The review covered only studies of cramps unrelated
to any underlying medical condition. Muscle cramps can be an indicator
of kidney or liver disease as well as neurological conditions, such as
amyotrophic lateral sclerosis (Lou Gehrig’s disease) or complications of diabetes. For that reason, anyone suffering from severe cramps should consult a doctor.

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